ANGIONEUROTIC EDEMA AND DERMATITIS VENENATALIKE LESIONS DUE TO THE ORAL ADMINISTRATION OF SULFATHIAZOLE

Abstract

very little pruritus and the mucous membranes were not involved. The urine at this time was amber ; specific gravity was 1.022; it was alkaline in reaction and negative for albumin, and sugar was 1 plus. Microscopic examination revealed many sulfaguanidine crystals, white blood cells and occasional red blood cells but no casts. The blood sulfaguanidine level was 2 mg. per hundred cubic centimeters on November 28. Otherwise the blood chemistry was unaltered. The patient looked extremely toxic. She felt nauseated and at 6 p. m. vomited a moderate amount of watery fluid. A record of the fluid intake and output for November 28 showed an oral intake of 2,600 cc. (reinforced by intravenous infusion of 1,000 cc. of 10 per cent dextrose in saline solution) with an output of only 130 cc. The following day, November 29, her pharynx was red and her tongue was coated but moist. She still had the generalized macular erythematous rash, which blanched on pressure. Under the continued regimen of forced fluids, her temperature dropped back to normal and by November 30 the cutaneous rash had practically disappeared. The red and white blood cells and crystals were no longer found in the urine and the patient was voiding adequately. There was no more nausea, vomiting or headache and the patient felt much better. COMMENT Sulfanilamide, sulfapyridine, sulfathiazole and, to some extent, sulfadiazine have all been exposed as to their toxic effects. Sulfaguanidine may be held under a similar indictment with the other members of the sulfonamide family. Despite its slow rate of absorption from the gastrointestinal tract, sulfaguanidine has produced its harmful side reactions and manifestations of irritation to organs. This seems to be the first noted instance of renal depression and irritation in human beings due to sulfaguanidine ; it was evidenced by the oliguria and by the presence of red and white blood cells in the urine. (Marshall and others have reported renal depression in experimental animals due to administration of sulfaguanidine.4)